La psychothérapie assistée par la MDMA dans la prise en charge du syndrome de stress post-traumatique

Posttraumatic stress disorder (PTSD) is estimated to remain chronic and severe for 25–50% of patients despite psychotherapeutic treatment. Part of the reasons is that patients with PTSD can have difficulties in establishing a good therapeutical alliance with the therapist. Moreover, they often fail to re-think the content of the trauma without being overwhelmed by negative emotions and tend to rely on avoidance strategies and/or to abandon the therapy. MDMA (“ecstasy”) is a drug classified as an entactogen (en “within”, tactus “touch”, and gen “produce”), an amphetamine with psychedelic properties that possesses psychopharmacological properties to overcome these issues. Indeed, MDMA triggers the release of oxytocin, which favors the establishment of interpersonal relationship based on kindness and trust. Moreover, MDMA diminishes the activity of the amygdale, allowing patients to work on challenging memories with less fear and anxiety. Finally, MDMA may also provide access to meaningful spiritual experiences, release of tensions and a sense of healing on a non-verbal level that are not completely understood. But are viewed as important by patients. Today, there is no evidence that the use of MDMA in a clinical setting has bad neurologic, psychological or cognitive consequences. Results of phase II trials in the United States and Europe confirm that MDMA favors psychotherapy's outcome without severe adverse effects. Phase III trials are underway. The Multidisciplinary Association for Psychedelic Studies (MAPS) has published online a method proposal and trains therapists in MDMA-assisted psychotherapy.ConclusionFood and Drug Administration (FDA) and European Medicines Agency (EMA) could approve this therapeutic tool in the coming years.     

Choosing what to choose from: Preference for inclusion over exclusion when constructing consideration sets from large choice sets

Decision making is a two‐stage process, consisting of, first, consideration set construction and then final choice. Decision makers can form a consideration set from a choice set using one of two strategies: including the options they wish to further consider or excluding those they do not wish to further consider. The authors propose that decision makers have a relative preference for an inclusion (vs. exclusion) strategy when choosing from large choice sets and that this preference is driven primarily by a lay belief that inclusion requires less effort than exclusion, particularly in large choice sets. Study 1 demonstrates that decision makers prefer using an inclusion (vs. exclusion) strategy when faced with large choice sets. Study 2 replicates the effect of choice set size on preference for consideration set construction strategy and demonstrates that the belief that exclusion is more effortful mediates the relative preference for inclusion in large choice sets. Studies 3 and 4 further support the importance of perceived effort, demonstrating a greater preference for inclusion in large choice sets when decision makers are primed to think about effort (vs. accuracy; Study 3) and when the choice set is perceived as requiring more effort because of more information being presented about each alternative (vs. more alternatives in the choice set; Study 4). Finally, Study 5 manipulates consideration set construction strategy, showing that using inclusion (vs. exclusion) in large choice sets leads to smaller consideration sets, greater confidence in the decision process, and a higher quality consideration set.     

Conducting Prolonged Exposure for PTSD During the COVID-19 Pandemic: Considerations for Treatment

The unprecedented effects and duration of the COVID-19 crisis are likely to elevate the population’s level of anxiety due to psychological stress, economic hardship, and social isolation. This effect may be especially potent for individuals with preexisting mental health conditions, such as posttraumatic stress disorder (PTSD). Prolonged Exposure (PE) therapy is a highly effective treatment for PTSD across trauma-exposed populations, and has been implemented effectively via telehealth. Nevertheless, PE implementation via telehealth may require specific adaptations during the COVID-19 crisis due to public health mandates calling for sheltering in place and physical distancing. This paper discusses strategies for implementing PE for PTSD during the COVID-19 pandemic, which may also be applied to other situations in which physical distancing must be considered.     

辩证行为疗法：理论背景、治疗效果及作用机制

辨证行为疗法（Dialectical Behavior Therapy, DBT）于20世纪90年代初由美国治疗师Linehan创立。作为第三代行为治疗之一,该疗法以行为主义理论、辩证哲学、生物社会理论及禅宗为哲学基础,通过增加患者的技能使用,提高其情绪调节能力,以达到治疗目的。临床研究已证明其在边缘人格障碍,自杀及自伤行为中具有良好的治疗效果,除此之外也广泛适用于其他心理障碍及群体。DBT的临床效果、改变机制及拓展应用都需进一步研究。     

青少年创伤后应激障碍症状与网络成瘾症状的关系：惩罚敏感性和孤独感的中介及性别的调节

汶川地震9.5年后,对汶川县和都江堰市767名中学生进行调查,考察惩罚敏感性和孤独感在创伤后应激障碍症状和网络成瘾症状之间的多重中介作用及性别差异。结果发现：（1）PTSD症状正向预测网络成瘾症状,并分别通过惩罚敏感性、孤独感的单独中介作用及两者的链式中介作用显著预测网络成瘾症状;（2）女性的PTSD症状显著正向预测网络成瘾症状,并分别通过惩罚敏感性和孤独感间接影响网络成瘾症状;男性的网络成瘾症状仅被PTSD症状正向预测。     

Coping strategies in obsessive-compulsive patients during Covid-19 lockdown

Background/ObjectiveThe main aim of this study was to compare coping strategies in obsessive-compulsive disorder (OCD) patients and a healthy control group during COVID-19 lockdown and to analyze the relationship with some variables which may influence results (depression, anxiety, comorbidity, subtype of obsession-compulsion). Method: There were 237 participants, 122 OCD and 115 healthy controls, aged 17-61 years old (M = 33.48, SD = 11.13). Results: Groups showed differences in the use of some adaptive strategies (positive reinterpretation, acceptance, humor) and maladaptive (denial, self-blame). Within obsessive-compulsive group, comorbidity affected the greater use of inappropriate strategies (denial, substance abuse and self-blame) while type of obsession-compulsion did not influence use. Anxiety and depression levels were related to the use of less adaptive strategies. Conclusions: These findings strengthen the need for training in the use of effective and adaptive coping strategies, making it necessary to improve clinical follow-up of these patients. It is relevant to be in contact with healthcare professionals, review medication and observe the anxiety and depression levels.     

The Role of Professional Training Experiences and Manualized Programs in ABA Providers’ Use of Parent Training With Children With Autism

Parent training, in which providers teach parents intervention strategies to promote their children’s skill acquisition and/or behavior management, is considered a best practice in the treatment for children with autism spectrum disorder (ASD) and yet is underutilized in community settings. The present study examined the role of training experiences and manual use in promoting the use of parent training by community providers who serve children with ASD. Applied behavior analysis (ABA) providers (N = 1,089) from across the United States completed self-report questionnaires online. The total number of professional training experiences related to parent training significantly predicted the extensiveness of providers’ use of parent training. Receiving supervision in parent training, being trained in a specific parent training approach, taking a course related to parent training, and participating in self-guided learning (e.g., webinar) were unique predictors of parent training extensiveness. While only 15% of ABA providers used manualized parent training programs, using a manual was also a unique predictor of parent training extensiveness. Parallel multiple mediator analyses demonstrated that family-, provider-, and organization-level barriers all partially mediated the relationship between number of training experiences and parent training extensiveness; only provider- and organization-level barriers mediated the relationship between manual use and parent training extensiveness. Recommendations for training and supporting providers at the pre-service and in-service levels are discussed as a means of increasing access to parent training for children with ASD in community settings.